Jefferson Medical College - Clinic Yearbook (Philadelphia, PA)

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a n the medical profession, usefulness is the measure of greatness. So wrote Dr. C. Wilson in his Memoir of M. Da Costa. If that be the yardstick, Iacob Mendez Da Costa certainly merits the mantle of great- ness. His usefulness-as with so many other prominent men in Iefferson's past-was both as a clinician and a teacher. His clinical skills were ap- plauded by his colleagues and he was considered a doctor's doctor. His teaching skills were equally -fine. Ac- cording to Fielding Garrison, the med- ical historian, Da Costa was perhaps the ablest clinical teacher of his time in the Eastern States. - Da Costa didn't attain this emin- ence casuallyg he was well prepared and he worked hard to perfect his skills. He gained a continental educa- tion in the classics as a youth and was stimulated by language and literature throughout his life. His primary med- ical education came at jefferson, where he was graduated at the age of 20 in 1852 after three years of study. His talents were recognized early, for he was singled out even then to demon- strate pathological anatomy to his fel- low students. His appetite for medical knowledge whet by his Jefferson ex- perience, Da Costa traveled to Europe to study in the leading medical centers of the world at that time-Paris and Vienna. His fluency in French and German allowed him to make better use of his opportunities than other American students. It also allowed him to enjoy the cultural attractions, and he even took the time for lessons in water-color painting. This later proved of great use to him in the preparation of sketches and diagrams for his teach- ing. His acceptance by French phy- sicians made it possible for him to attend meetings of the Academie da Medecine, which were open to few American visitors. After studying under the leading physicians and pathologists of Europe, he returned to Philadelphia and began a career that was to stretch nearly 50 years. His initial successes were as a teacher, for he had to prove himself over several lean years before his prac- tice grew. His classes in physical diag- nosis were particularly popular and even drew graduate physicians. These classes were conducted in his office and added to his growing reputation. He continued to conduct private classes until he began lecturing at jefferson in 1858-a mere six years after his graduation. He remained closely tied to Iefferson for the ensuing decade and in 1872 when only 39 years old he was appointed to the Chair of the Theory and Practice of Medi- cine. Da Costa's greatest contribution came eight years before this, when the first edition of his Medical Diagnosis was published. This volume, revised nine times by Da Costa to stay abreast of new medical discoveries, was the preeminent work in its field for four decades. It was translated into every European language and was found on nearly every physician's bookshelf. Ac- cording to an early Da Costa biogra- pher: It claimed the admiration of the medical world. It was the forerunner of other works of its kind but has held its place during 38 years. New works have appeared, some modelled on its lines, but none has rivalled it in scope, in teaching power or in its matchless grace of composition. Competent critics have pronounced it to be the most elaborate work on diagnosis in the English language. Even in the library of the irregular practitioner it has an exalted place. - 1n his book, as in his lectures, Da Costa taught the method of diagnosis by exclusion, which has carried over to the present. His style of writing and speaking were described as simple, natural, lucid, emphatic. This was his strength. He was able to convey con- cepts in a nutshell to grateful stu- dents. Another great contribution was his emphasis on clinical teaching, which was revolutionary for the time. Most medical teaching at that time, according to Garrison, was a mere pedagogic rubbing in of what had already been heard in routine lectures with hardly any practical clinical ex- periences whatever. W. W. Keen paid tribute to Da Costa's contribution, pointing out that the Philadelphia clinics until Da Costa in the session of 1866-67 took hold of them were about as inane and useless as one could imaginef' Da Costa's style alone was enough to attract students and Ere their imaginations. Some feeling for his presentation can be gained from this description in an obituary in H arvard voiced the uni- versal sentiment of the phy- sicians of America that this is the man whom we delight to honor Medical News shortly after his death in 1900: His language was always well chosen and he never hesitated for the correct word. He was a student of correct diction, and both in his lectures and in his writings showed his familiarity with the English classics. He also showed his wide extent of medical readings by refer- ences to French and German au- thorities.

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personality, according to Earnest, that filled neurotic patients with hope and confidence. It also brought him wealth, conceit and absurd adulation, the biographer reports, but despite it all he never became a stuffed shirt. Probably this was so because his mind was too active to be cast in a mold of smugness. He was always eager to seek out a new truth or accept a new challenge. A decade before he evolved his rest cure he contributed major neurological works stemming from his observations during the Civil War. Publication of Gunslfzot Wotrnds and Other Injuries of Nerves in l864 as- sured him a place in medical history. While that work was produced in collaboration with William Williams Keen-who was to become a lifelong friend-and George R. Morehouse, biographers agree that Mitchell was the prime contributor. Keen at the time was a young physician, newly graduated from Jefferson and years away from his world-renowned achieve- ments in brain surgery, and Morehouse never attained the stature of his two fellow researchers. Gunslzot Wmands was such a valuable work that an ex- panded version-written by Mitchell alone-was still in use by the French Army during VVorld War l. That it is a neurological masterpiece is certain. The presence of motor centers in the forebrain controlling muscles on the opposite side of the body was postu- lated for the first time. This was the basis for Mitchell's later work delineat- ing the functions of the cerebellum. This work, along with his research on snake venom-which led to later dis- coveries in toxicology and immunology -is the basis for his reputation as a scientific researcher. During his work on the cerebellum, he experimented on pigeons, rabbits and guinea pigs, rely- ing mainly on three methods-ablation, freezing and irritation. He correctlv determined that the cerebellum plavis a role in influencing the main motor tracts from the brain. His other con- tributions to neurology were his de- scriptions of clinical entities he had observed, including postparalytic cho- rea, disorders of the sensorium and the relationship of seasons to depressive states. As Mitchell grew older and more successful, his mind turned to other pursuits: he entered the world of let- ters, As poet and novelist, according to Fielding Garrison, Mitchell has a place near Goldsmith and Holmes. In literature as in medicine he followed in the footsteps of his father, John Kearsley Mitchell, sometime poet and professor of medicine at JeHerson. liar- nest rates Mitchell as a Hrst-rate writer, but contends that in literature he is less secure in his reputation than as a physician. However, he notes, ln a period when American novels were chiefly designed for hammock reading, Mitchell's have an intellectual quality which is rare among his contemporary writers. The biographer also compares Mitchell to Holmes Canother physi- cian-authorD, as well as Henry James. James is of course the greatest, Ear- nest says, but Mitchell, using a similar social milieu, has a health which James lacks. Mitchell relied for much of his inspiration on his Givil War experi- ence and his knowledge of abnormal psychology. His literary career began in earnest after he passed the age of 50, but thereafter he was prolific. Sev- eral explanations can be found for his late start. According to one story Mit- chell submitted a volume of poems to a Boston publisher when he was only 20. Supposedly, Holmes saw the manu- script and advised the young man to secure his medical practice before at- tempting to dabble in literature. Ac- cording to another version, Mitchell feared that his patients would have little confidence in a physician inter- ested in writing poetry. Nevertheless, he published several works anony- mously before tackling serious writing in middle age. While Mitchell was basically an academic luminary, he never held any academic position of note. Perhaps this was because he was rebuffed early in his career when he applied for chairs in physiology at Jefferson and later at the University of Pennsylvania. When offered a professorship in medicine at Penn years afterward he turned it down, but apparently not out of en- mity, for he served that institution for 35 years as a trustee and was instru- mental in establishing its school of biology. Perhaps he aided this en- deavor because he was alwavs on the alert for promising young men, hoping to point them on the way to sueeess, ln doing so, according to Earnest he n P left mark on three generations of physicians and scientists. gg n the i5 Ill So Merrwif the Yard ceflainlf ness- H1 Olllef pl paSt'Wa teacher' plallded Consider' teaching cordirlgl ical liisti the able: in the Ei Da ence CHS and he skills. Hr tion in tl stimulate througho ical educ he was g 1852 aft talents v was singl strate pa low studl knowledg perience, to study of the ll Vienna. German use of A Americar i0 Enjoy he even Walerfol of great Qf Sketch His sncrans r attend If Mfblecin AmCI'lC3I- Physici he rctu H Career Yea OVQ llCQ flogis X even dl I Ser gre

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His lectures, therefore, were not only informative, but were enjoyable, challenging experiences. There is evi- dence that they attracted, besides phy- sicians and medical students, members of other professions. Da Costa's long- time secretary, Mary A. Clarke, 1'el21fCS that a lawyer from a distant city ad- mitted that it had been his habit for years to spend three days of every win- ter in Philadelphia to hear Dr. Da Costa lecture. As a clinician, Da Costa contrib- uted both new knowledge to advance his profession and sound therapy to those patients referred to him. His rep- utation in cardiology followed publica- tion of a classic paper, On I1-ritalole Heart, which resulted from studies on soldiers during the Civil War. His writ- ings were significant but he was not pro- lific. Viewed in the light of his remarkable influence on the profession, Wilson points out, the list of titles of his papers appears singularly brief. Yet, as Wilson adds, he wrote when he had something to say, and he always said it well. His small bibliography notwithstanding, he was recognized everywhere for his professional and in- tellectual attainments. Evidence for this is the honorary degrees conferred on him by Harvard, the University of Pennsylvania and Jefferson. He ac- cepted each of these honors with a brief oration in faultless Latin-a legacy of his classical education. Commenting on the Harvard honor, a medical jour- nal of the day said: Harvard voiced the universal senti- ment of the physicians of America that this is the man whom we delight to honor. His work, teaching, exam- ple and advice have done so much to advance the art and science of medi- cal practice that no honor could be too great an acknowledgement. Da Costa held membership in many professional and scientific or- ganizations, but none was closer to his heart than the Philadelphia College of Physicians, which he served twice as president. He battled for years to get members of the College to speak out publicly on medical questions of the day. He set the example by campaign- ing for the city to change the source of its water supply from the Schuylkill, which was polluted even then, to the Delaware, which was clear. The Col- lege of Physicians backed Da Costa, but the politicians were unmoved. Nevertheless, many memberS Of the community benefited because they were alerted to the danger. A great number of them boiled their water be- fore drinking it, and many iIlfCCti0D5 were undoubtedly prevented- Leisure time is cherished by every physician, and Da Costa was no dif- ferent. He loved books, and spent many hours reading outside of his profession. According to his secretary, his one idiosyncrasy in this regard was his inability to truly enjoy a book unless he owned it. Thus, his library was one of the largest private collec- tions in Philadelphia. His interest in literature led him to membership in Shakespeare Club of Philadelphia. Other English authors he admired were Thackeray and Sir Arthur Helps. As with so many other successful men-before and since-Da Costa was extremely efficient in the use of his time. He was an early riser and ac- complished much of his reading before the work day began. He seized on brief moments in the day to dictate letters or accomplish other necessary tasks, wasting little of his precious time. Yet he was always gracious and never seemed hurried as he made his rounds or saw patients in his office. He gave all patients the impression that their illness completely absorbed him, and he never left the bedside without directing a last, comforting remark directly to the patient. Jacob Mendez Da Costa was the first of two brilliant clinicians of that sur- name to be associated with Jefferson. J. Chalmers Da Costa would dominate the institution years after him. The two men were unrelated, just as they were unlike. Jacob was a truly out- standing clinician, but when he began his career at Jefferson he had to share honors with the Samuel D. Cross and Joseph Pancoast, giants of medicine at that time. It is a measure of the man that he was included in what the medi- cal world began referring to as Jeffer- son's great trio. It is further to his credit that he continued to Contribute to his profession for nearlv a half- century-until the day of his death in 1900 of a heart attack. lf, as Wilson suggests, 'usefulness is the meagure of greatness in medicine, Jacob Mendez Da Costa surely ranks among the great clinicians of the last century. i l lf Sei HCCI- n0f ' canal mater Prem 3 CHIT cause fan cover openf lenC6 durin CHHCE Wooc charai ward since Jell Finlay ready studer Bache lost h Philac claims physit was Jr of me monog gin of foury ferson the et rect, J We that 5 not cg 51 vectr ll Parent Slllder Son, S The father Scienc. Career father faughr Stope- medic ICSEHI4 fflend H Wm. Finla5 few, A Finlay and 6 S0011 -